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bankshot7

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(This is a question from a newbie.) During my initial visit/ wellness exam the doctor ordered an EKG, but the machine was not working at the time of the visit and could not be done. On a subsequent diagnostic visit (for allergies) the machine was working, so the EKG was done then. It's being billed as diagnostic - CPT 93000. Can it be associated with the wellness visit?
 
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I'd call the doctor's office

I'd call the doctor's office and say just what you've said in the forum. The EKG was part of the wellness exam .. just wasn't done then because the machine wasn't working.

I'm guessing this was a human error. You were there for a sick visit, you had an EKG, ergo it must have been diagnostic. (See what happens when we assume?)

Let them know that you'd be happy to put your position in writing with a copy to your insurance carrier if that would help.

F Tessa Bartels, CPC, CEMC
 
The office was called

Yes, I fully agree. I called the office several weeks ago when I received the bill. They acknowledged seeing the date of the doctor's order coinciding with the wellness visit; but they hedged on their intent to follow up by stating "all we can do is resubmit it and see what happens." Now the second billing for it has arrived boldly marked "Overdue", and phone messages are not being returned.

I'm new to coding, and see the opportunity for real-world examples that affect me personally to augment my complete education! What might the doctor's office be missing to submit it so as to be paid? Is CPT 93000 only for a diagnostic EKG, or is there a modifier? Any advice is appreciated!
 
Why did insurance deny?

Okay ... I think I may have misinterpreted your post. Were you billed for this twice? Once on the date of the first visit and again when it was actually performed?

Why did insurance deny? Perhaps your insurance carrier has a customer service area that can help explain why it was denied.

93000 is for a routine diagnostic EKG ("with interpretation and report") ... if the doctor didn't do the report then I believe the code should be 93005.

I think it's terrible that they are not returning your phone calls!

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
Some info from insurance provider

I wasn't double-billed; I meant only that an entire billing cycle elapsed, and now here's the same bill but with aging. I called my insurance provider and they told me that no coding was ever received to associate the EKG with a routine health exam. They also advised that the time limit for adjustment or appeal has now passed.

I wrote a letter to the Billing Manager documenting this information and explaining my position. (My initial response was very timely; it does not appear that any action was taken to modify coding, etc.)

As for the coding, the insurance provider said they would have looked for ICD-9 coding. Just curious - I'm thinking that a V Code would have done it.

V70.0 Routine general medical examination at a health care facility

Is that correct? What is the accepted format to notate this?
 
Followup: Semantics

I called the office and insisted on talking to someone live. Now they are saying that I never had a wellness exam - "these are never done during the first visit".

They have documented I instead had a first-visit physical examination during which I reported arrhythmia. Therefore the EKG is diagnostic. (I haven't had any arrhythmia for years and thought I was including it in the patient history of my wellness exam! I was very clear about the historical and non-persistent aspect at the time) They are saying my second visit also supports the need for a diagnostic EKG.

Because of this documentation the office does not consider the bill to be in dispute.

That's the latest! :eek: When are wellness exams usually done? How is a wellness exam different from a first-time physical exam to establish service?

By its nature is an EKG always coded as diagnostic? Has anyone ever used modifiers to associate it with a general physical exam?
 
Yes you are correct about the V code.

An EKG is indicated as part of wellness by the diagnosis code (normally V70.0). If there is an indication or symptom, it is diagnostic. I assume you are asking because you get better benefits for wellness exams? A simple corrected claim should get it resolved. I would ask for a copy of the HCFA (still can't call it CMS) so you can deal with your carrier directly.
 
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